丹参注射液椎管内局部灌注对急性脊髓损伤的保护作用

目的 探讨丹参对急性脊髓损伤的防治作用。方法 以改良Allen's法造成兔不完全性脊髓损伤的模型,硬膜下插管。随机分成丹参治疗组和对照组。术后按每天0.3ml/kg体重的总量分4次从硬膜下导管推入丹参注射液,对照组推入生理盐水。损伤后8、72h对脊髓损伤区进行过氧化物歧化酶(SOD)、丙二醛(MDA)、组织形态学观察、神经元凋亡、bcl-2等进行评价。结果 丹参组SOD含量高于对照组(P<0.01),MDA含量低于对照组(P<0.01)。细胞凋亡数目TUNEL法丹参组低于对照组(P<0.01),流式细胞术检测凋亡丹参组低于对照组(P<0.05)。bcl-2的表达丹参组高于对照组(P<0.05)。神经元及神经纤维变性、坏死轻于对照组。结论 丹参能改善损伤脊髓微循环,抑制和减轻脊髓损伤后的两种死亡方式坏死和凋亡。     

Selective dorsal rhizotomy: long-term experience from Cape Town

Introduction Given the large number of cerebral palsy patients who have undergone selective dorsal rhizotomy in the past two decades, it is clearly imperative that the clinical community be provided with objective and compelling evidence of the long-term sequelae of the procedure. Materials and methods In the early 1980s, Peacock in Cape Town shifted the site of the rhizotomy from the conus medullaris to the cauda equina, and in the past 25 years, more than 200 children have been operated on. We have studied the incidence of spinal deformities after multiple-level laminectomy and recorded a 20% incidence of isthmic spondylolysis or grade-I spondylolisthesis. We have also conducted a long-term prospective gait analysis study on a cohort of 14 ambulatory patients who were operated on in 1985. Results Ten years after surgery, our patients had increased ranges of motion that were within normal limits. Step length was significantly improved, although cadence was unchanged postoperatively and was significantly less than normal age-matched control subjects. Discussion We have recently tracked down all 14 patients from the original cohort and are currently completing a 20-year prospective follow-up analysis of their neuromuscular function and gait. Our preliminary data suggest that selective dorsal rhizotomy is not only an effective method for alleviating spasticity but it also leads to long-term functional benefits.     

350例脊髓血管畸形介入治疗的护理分析

目的探讨护理工作在脊髓血管畸形介入治疗中的价值。方法通过对我院介入中心350例脊髓血管畸形患者介入治疗,针对脊髓血管畸形患者的临床特点和介入治疗方法的适应证、操作过程和预后等特点,从护理学的角度对术前、术中、术后等阶段进行讨论分析。结果术前进行有效的心理护理和健康教育;术中与介入医生及技术操作人员进行有机的配合、熟练使用输液微量泵、准确使用相关药物及认真观察病情变化;术后对患者进行严密的护理观察,可减少并发症的发生,将有助于该手术的成功。结论介入护理工作对脊髓血管畸形介入治疗手术的成败起着至关重要的作用。     

后路椎间融合术治疗成人腰椎滑脱的前瞻性研究

目的前瞻性比较采用自体髂骨块和椎间融合器治疗成人腰椎滑脱的效果。方法自1998年2月～2002年2月治疗78例腰椎滑脱患者,所有患者均行椎弓根螺钉固定、后路椎间融合术,根据椎间融合材料的不同,前瞻性将患者随机分为融合器组36例(采用后方斜向单枚椎间融合器)和自体骨组42例(采用自体髂骨块)。男33例,女45例;年龄35～59岁,平均43岁。其中Ⅰ度滑脱29例,Ⅱ度滑脱39例,Ⅲ度滑脱10例。比较两组患者的基本情况、临床效果和影像学结果(融合率和手术节段椎间隙高度的变化)。结果术后随访2年～3年7个月,平均35个月。两组在性别、年龄、滑脱程度、手术时间、失血量以及住院时间上差异无显著性,两组患者均无严重并发症。融合器组优良率为88.8%,自体骨组为83.2%(P=0.99)。术后1年融合器组的融合率为86.1%,自体骨组为83.3%,两组间差异无显著性意义(P=0.87);最终随访时椎间隙高度融合器组平均减少1.7 mm,自体骨组平均减少2.6 mm,两组间差异有非常显著性意义(t=1.38,P< 0.005)。结论采用自体骨为植骨材料者术后椎间隙高度丢失明显增加,但两组之间融合率和临床优良率差异无显著性。椎间融合器和自体髂骨块均可以作为腰椎滑脱后路椎间融合的植骨材料,临床疗效好。     

单节段与双节段椎弓根螺钉固定胸腰椎单椎体骨折的生物力学比较

目的:比较单节段与双节段椎弓根螺钉固定术固定胸腰椎单椎体骨折的生物力学效果。方法:在16具新鲜小牛胸腰椎标本(T11-L3)的L1椎体上制作不完全爆裂骨折模型,分为两组,分别行单节段与双节段椎弓根螺钉固定,对固定后的标本施加扭矩为4Nm的疲劳载荷共2000次,加载频率为0.5Hz,经脊柱三维运动测量系统测量正常、损伤、固定和周期性加载后固定节段前屈/后伸、左/右侧弯和左/右旋转运动时固定节段的运动范围。结果:单节段固定组前屈、后伸、侧屈、旋转稳定指数(SPI)分别为0.78、0.80、0.92、0.83,双节段固定组SPI分别为0.88、0.89、0.95、0.85,在前屈方向单节段固定组明显小于双节段固定组(P<0.01);疲劳后,单节段固定组SPI在前屈、后伸、侧屈、旋转方向分别降低0.05、0.03、0.05、0.11,降低值均大于双节段固定组,且在旋转和侧屈方向有显著性差异(旋转:P<0.01;侧屈:P<0.05)。结论:两种术式均可重建脊柱骨折即刻稳定性,效果无明显差异。在旋转、侧屈方向,双节段椎弓根螺钉固定术抗疲劳载荷效果优于单节段固定术。     

神经根修复时间对脊髓前角运动神经元存活的影响

目的评价神经根修复时间对脊髓前角运动神经元存活的影响。方法采用大鼠颈。神经根性撕脱伤和椎孔外切断实验动物模型，根据动物神经根损伤类型和损伤后修复时间分为A、B、C、D四组，每组16只。A、C组分别将撕脱与切断的神经根即刻回植入脊髓和于椎孔外直接吻合，B、D组将撕脱和椎孔外切断的神经根旷置3周后再重复上述手术。分别于神经根撕脱和椎孔外切断术后3周、3个月、6个月取材。应用组织病理活检、免疫组化技术及神经示踪技术，对神经中枢及吻合口下段神经干检查，观察脊髓病理改变和轴突再生情况，进行A、B组和C、D组间对比。结果臂丛神经根性损伤即刻修复组脊髓前角运动神经元和尼氏体数目、形态、减少程度及周围再生神经纤维数目、发育程度均优于损伤后3周修复组。结论神经根早期修复对脊髓前角运动神经元有明确的保护作用，对外周神经再生有促进作用。     

Metabolism and binding of androgens in the spinal cord of the rat

The binding of [3H]androgens and estrogens, and the metabolism of [3H]androgens, were studied in the spinal cord of the adult rat. High-affinity, specific binding sites for [3H]testosterone and [3H]estradiol were detected in cytosol fractions from the spinal cords of castrate animals. Equilibrium dissociation constants for reaction of these sites with their respective ligands were similar to those of androgen and estrogen receptors from other regions of the central nervous system. Nuclear binding of [3H]estradiol was observed in the spinal cord 1 h after intravenous administration of the isotope. Likewise, exchange assay demonstrated the presence of high-affinity androgen binding sites in spinal cord nuclei from orchidectomized, testosterone propionate treated animals. 5 alpha-Reductase activity in homogenates of the spinal cord was relatively high, approximately 3 times that in the pooled hypothalamus, preoptic area, septum and amygdala. However, in contrast to the latter brain regions, estrogen formation was not detectable in spinal cord tissue. No sex differences were observed in the metabolism of [3H]testosterone by spinal cord homogenates. These results confirm the presence of androgen and estrogen receptors in the rat spinal cord. The lack of detectable aromatase activity in the spinal cord is consistent with the hypothesis that the effects of circulating testosterone on spinal reflex function are mediated primarily through the androgen receptor system.     

Spinal arteriography: a primer

Spinal arteriography is an esoteric procedure that is seldom nerformed by peripheral interventionalists. This presentation is intended to outline some of the essential points that the interventionalist performing the procedure should be aware of,especially about spinal dural arierioyenous fistulae (SDAVF).     

肿瘤坏死因子及中性粒细胞在脊髓继发性损伤中的作用

目的 探讨炎性反应对脊髓损伤细胞凋亡的影响及其作用机制。方法 健康Wistar大鼠48只。随机分为2组，实验组与对照组。采用Allen法挫伤大鼠T10节段脊髓，于术后1、8h和1、2、3、7d取材。检测肿瘤坏死因子（TNF）与髓过氧化物酶水平的变化。结果 实验组肿瘤坏死因子与髓过氧化物酶水平均明显升高（P〈0．01）。结论 中性粒细胞及TNF-α参与了脊髓继发性损伤，并可能是触发迟发性神经元凋亡的重要因素之一。     

Fusimotor reflexes to antagonistic muscles simultaneously assessed by multi-afferent recordings from muscle spindle afferents

Several single agonist/antagonist primary muscle spindle afferents were simultaneously recorded in chloralose anaesthetized cats. It was shown that their dynamic and static sensitivity to sinusoidal muscle stretches could be increased or decreased via the fusimotor system by extension and flexion of the contralateral hind limb as well as by stretch of ipsilateral muscles and stimulation of ipsilateral skin nerves. The results seem to support the hypothesis that the primary muscle spindle afferents convey complex multisensory messages to the central nervous system (CNS).